Sick sinus syndrome unless a functioning ventricular pacemaker is in place. Acute Hepatic Injury: In rare instances, significant elevations in enzymes such as alkaline phosphatase, LDH, SGOT, SGPT, and other phenomena consistent with acute hepatic injury have been noted. These reactions have been reversible upon discontinuation of drug therapy. The relationship to Cardizem is uncertain in most cases, but probable in some see PRECAUTIONS. Remember, keep this and all other medicines out of the reach of children, never share your medicines with others, and use this medication only for the indication prescribed.
Massie B, MacCarthy EP, Ramanathan KB et al. Diltiazem and propranolol in mild to moderate essential hypertension as monotherapy or with hydrochlorothiazide. Ann Intern Med. Schrager BR, Pina I, Frangi M et al. Diltiazem, digoxin interaction? Dias VC, Weir SJ, Ellenbogen KA. Pharmacokinetics and pharmacodynamics of intravenous diltiazem in patients with atrial fibrillation or atrial flutter. Circulation. Safety and effectiveness in pediatric patients have not been established. Frishman WH, Charlap S, Michelson EL. Calcium channel blockers in systemic hypertension. Am J Cardiol.
Ranitidine produced smaller, non-significant increases. Take this medication by mouth with or without food, usually once daily at the same time or as directed by your doctor. Do not crush or chew extended-release tablets. Doing so can release all of the drug at once, increasing the risk of side effects. Also, do not split the tablets unless they have a score line and your doctor or pharmacist tells you to do so. Swallow the whole or split tablet without crushing or chewing. Depending on your specific brand, take this medication either in the morning or at bedtime as directed. Consult your pharmacist if you have any questions about when to take the medication.
Is diltiazem available as a generic drug? The Expert Panel coordinated by the National Heart, Lung, and Blood Institute. Report of the National Cholesterol Education Program Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults. Arch Intern Med. Weber MA, Schiffrin EL, White WB et al. Clinical practice guidelines for the management of hypertension in the community: a statement by the American Society of Hypertension and the International Society of Hypertension. J Clin Hypertens Greenwich. While you are taking this medicine, you should avoid eating grapefruit or or drinking grapefruit juice. You may choose an alternative citrus beverage such as orange juice.
Cardizem 90 mg scored tablets are supplied in bottles of 100 NDC 0187-0791-47. Each green, oblong tablet is engraved with Cardizem on one side and 90 mg on the other. Roti E, Montermini M, Roti S et al. The effect of diltiazem, a calcium channel-blocking drug, on cardiac rate and rhythm in hyperthyroid patients. Arch Intern Med. Mitka M. Groups spar over new hypertension guidelines. JAMA. Risk of heart failure, especially in those with preexisting ventricular impairment; limited experience in patients with impaired ventricular function receiving concomitant β-adrenergic blocking agents. 100 138 187 237 251 254 256 258 274 323 Use with caution. Diltiazem is called a channel blocker. It works by relaxing vessels in the body and so can flow more easily. Prinzmetal's angina developed asystole after a single, 60 mg dose. Monitor ECG and BP continuously during IV administration. Administer over 2 minutes. Yoshida A, Fujita M, Kurosawa N et al. Effects of diltiazem on plasma level and urinary excretion of digoxin in healthy subjects. Clin Pharmacol Ther. Cardizem diltiazem hydrochloride is extensively metabolized by the liver and excreted by the kidneys and in bile. As with any drug given over prolonged periods, laboratory parameters of renal and hepatic function should be monitored at regular intervals. The drug should be used with caution in patients with impaired renal or hepatic function. In subacute and chronic dog and rat studies designed to produce toxicity, high doses of diltiazem were associated with hepatic damage. National Heart, Lung, and Blood Institute National High Blood Pressure Education Program. The sixth report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure JNC VI. Bethesda, MD: National Institutes of Health; 1997 Nov. NIH publication No. 98-4080. WebMD User Reviews should not be considered as medical advice and are not a substitute for professional medical advice, diagnosis, or treatment. Never delay or disregard seeking professional medical advice from your physician or other qualified healthcare provider because of something you have read on WebMD. You should always speak with your doctor before you start, stop, or change any prescribed part of your care plan or treatment. WebMD understands that reading individual, real-life experiences may be a helpful health information resource but they are never a substitute for professional medical advice from a qualified healthcare provider. American Heart Association Task Force on Practice Guidelines Committee on Management of Acute Myocardial Infarction. From ACC website.
Opie LH, Messerli FH. Nifedipine and mortality: grave defects in the dossier. Circulation. Cardizem CD and Cartia XT extended-release capsules: Maximum 480 mg daily. Food and Drug Administration. WebMD does not endorse any specific product, service, or treatment. Buring JE, Glynn RJ, Hennekens CH. Calcium channel blockers and myocardial infarction: a hypothesis formulated but not yet tested. JAMA. Ask your health care provider any questions you may have about how to use Cardizem. Experience with the use of Cardizem alone or in combination with beta-blockers in patients with impaired ventricular function is very limited. Caution should be exercised when using the drug in such patients. Fixed high-degree AV block should be treated with cardiac pacing. Alderman M, Madhavan S, Cohen H. Calcium antagonists and cardiovascular events in patients with hypertension and diabetes. Lancet. Follow all directions on your prescription label. Your doctor may occasionally change your dose to make sure you get the best results. Do not use this medicine in larger or smaller amounts or for longer than recommended. Other medications can affect the removal of diltiazem from your body, which may affect how this medication works. Examples include cimetidine, quinidine, St. John's wort, azole antifungals such as ketoconazole, macrolide antibiotics such as erythromycin, rifamycins including rifabutin and rifampin. Inhibitors, inducers, and substrates of CYP3A4: potential pharmacokinetic interaction altered plasma diltiazem concentrations. Lenfant C. The calcium channel blocker scare: lessons for the future. Circulation. Following oral administration of conventional tablets, approximately 80% of a dose is rapidly absorbed from the GI tract.
Your blood pressure will need to be checked often. You may also need frequent blood tests. Food and Drug Administration. Administer by direct IV injection, continuous IV infusion, or orally. Packer M, Kessler PD, Lee WH. Calcium-channel blockade in the management of severe chronic congestive heart failure: a bridge too far. Circulation. Thomas G, Shishehbor M, Brill D et al. New hypertension guidelines: one size fits most? Cardizem is a calcium channel blocker. Get emergency medical help if you have signs of an allergic reaction: hives; difficult breathing; swelling of your face, lips, tongue, or throat. In: Tatro DS, Olin BR, Hebel SK eds. Drug interaction facts. Exclusivity is the sole marketing rights granted by the FDA to a manufacturer upon the approval of a drug and may run simultaneously with a patent. Exclusivity periods can run from 180 days to seven years depending upon the circumstance of the exclusivity grant. Maintenance IV infusion: Dosage requirements may be lower.
Anon. Groups act to dispel concerns about calcium-channel blockers. Am J Health-Syst Pharm. If effects persist during therapy, the drug should be discontinued. 100 138 237 Potential for occurrence with IV administration. Pepine CJ, Cohn PF, Ellenbogen KA. Advisory group reports on silent myocardial ischemia, coronary atherogenesis, and cardiac emergencies. Am J Cardiol. Take the missed dose as soon as you remember. Skip the missed dose if it is almost time for your next scheduled dose. Do not take extra medicine to make up the missed dose. What happens if I overdose? PREGNANCY and BREAST-FEEDING: If you become pregnant, contact your doctor. You will need to discuss the benefits and risks of using Cardizem while you are pregnant. Cardizem is found in breast milk. Do not breast-feed while taking Cardizem. In: Tatro DS, Olin BR, Hebel SK, eds. Drug interaction facts. III-368. Abstract No. 1471. Ask your pharmacist about using those products safely. Leenen FHH, Nwachuku CE, Black HR et al. Clinical events in high-risk hypertensive patients randomly assigned to calcium-channel blocker versus angiotensin-converting enzyme inhibitor in the Antihypertensive and Lipid-Lowering treatment to prevent Heart Attack Trial. Hypertension. Frishman WH, Charlap S, Goldberger J et al. Comparison of diltiazem and nifedipine for both angina pectoris and systemic hypertension. Am J Cardiol. Clair WK, Wilkinson WE, McCarthy EA et al. Treatment of paroxysmal supraventricular tachycardia with oral diltiazem. Clin Pharmacol ther. Other medications can affect the removal of from your body, which may affect how this works. Cyclosporine Sandimmune drug interaction: Diltiazem Cardizem. In: Hansten PD, Horn JR. Drug interactions analysis and management. Sunderrajan S, Reams G, Bauer JH. Long-term renal effects of diltiazem in essential hypertension. Angina Due to Coronary Artery Spasm: Cardizem has been shown to be a potent dilator of coronary arteries both epicardial and subendocardial. Spontaneous and ergonovine-induced coronary artery spasms are inhibited by Cardizem.
May be used for relief of ongoing ischemia or to control rapid ventricular response with atrial fibrillation after an acute MI when β-adrenergic blocking agents are ineffective or contraindicated, but only in patients in whom there is no evidence of heart failure, left-ventricular dysfunction, or AV block and only after weighing carefully the potential benefits versus risks, particularly negative inotropic effects and concerns about short-acting formulations of the drugs. Hansson L, Zanchetti A, Carruthers SG et al. Effects of intensive blood-pressure lowering and low-dose aspirin in patients with hypertension: principal results of the Hypertension Optimal Treatment HOT randomised trial. Lancet. CARDIZEM tablets and CARDIZEM SR capsules is observed. BID diltiazem SR resulted in a 5-fold increase in mean simvastatin AUC versus simvastatin alone. Subjects with increased average steady-state exposures of diltiazem showed a greater fold increase in simvastatin exposure. Computer-based simulations showed that at a daily dose of 480 mg of diltiazem, an 8- to 9-fold mean increase in simvastatin AUC can be expected. Diltiazem hydrochloride is a white to off-white crystalline powder with a bitter taste. It is soluble in water, methanol, and chloroform. It has a molecular weight of 450. Warning: The facts and figures contained in these reports are accurate to the best of our capability; however, our metrics are only meant to augment your medical knowledge, and should never be used as the sole basis for selecting a new medication. As with any medical decision, be sure to work with your doctor to ensure the best choices are made for your condition.
Cardizem is given as an injection at your doctor's office, hospital, or clinic. Contact your health care provider if you have any questions. Psaty BM, Heckbert SR, Koepsell TD et al. The risk of incident myocardial infarction associated with anti- hypertensive drug therapies. Circulation. Nutley, NJ: Roche Laboratories; 1997 Dec. Wright JT, Dunn JK, Cutler JA et al. Outcomes in hypertensive black and nonblack patients treated with chlorthalidone, amlodipine, and lisinopril. JAMA. Tiazac and Taztia XT extended-release capsules: Maximum 540 mg daily. The harder the heart works, the more oxygen it requires. Management of unstable angina in patients who have continuing or ongoing ischemia when therapy with β-blocking agents and nitrates is inadequate, not tolerated, or contraindicated and when severe left ventricular dysfunction, pulmonary edema, or other contraindications are not present. Strubelt O. Antidotal treatment of the acute cardiovascular toxicity of verapamil. Acta Pharmacol Toxicol Copenh. Höglund P, Nilsson LG. Pharmacokinetics of diltiazem and its metabolites after single and multiple dosing in healthy adults. Ther Drug Monit. Reams GP, Lau A, Messina C et al. Efficacy, electrocardiographic and renal effects of intravenous diltiazem for essential hypertension. Am J Cardiol. Hospira, Inc. Diltiazem hydrochloride powder for solution prescribing information. Lake Forest, IL; 2008 Jan. Ivabradine: Concurrent use of diltiazem increases exposure to ivabradine and may exacerbate bradycardia and conduction disturbances. Avoid concomitant use of ivabradine and diltiazem. Andrx Pharmacueticals. Ft. Lauderdale, FL: Personal communication.
American Stroke Association. Stroke. Carbamazepine: Concomitant administration of diltiazem with carbamazepine has been reported to result in elevated serum levels of carbamazepine 40% to 72% increase resulting in toxicity in some cases. Patients receiving these drugs concurrently should be monitored for a potential drug interaction. If there is no response to vagal blockade, administer isoproterenol cautiously. This drug may make you dizzy. Do not drive, use machinery, or do any activity that requires alertness until you are sure you can perform such activities safely. Limit alcoholic beverages. Diltiazem is excreted in human milk. Tiazac extended-release capsules and Cardizem LA extended-release tablets: Maximum 540 mg daily. Some patients may respond to higher dosages of up to 360 mg once daily. Milner MR, Phillips RA, Gelman K et al. Are calcium antagonists as effective as beta blockers for the treatment of thyrotoxicosis? Apotex Corp. Dilt-XR diltiazem hydrochloride extended-release capsules once-a-day dosage prescribing information. Weston, FL; 2003 Dec. In domestic placebo-controlled angina trials, the incidence of adverse reactions reported during Cardizem therapy was not greater than that reported during placebo therapy. Eimer M, Carter BL. Elevated serum carbamazepine concentrations following diltiazem initiation. Drug Intell Clin Pharm. These effects can occur even if grapefruit is not consumed at the same time of the diltiazem dose This interaction may occur at any time in your treatment with diltiazem if grapefruit or grapefruit juice is consumed. Go AS, Bauman MA, Coleman King SM et al. An effective approach to high blood pressure control: a science advisory from the American Heart Association, the American College of Cardiology, and the Centers for Disease Control and Prevention. Hypertension. Cooper DS, Ridgway EC. Clinical management of patients with hyperthyroidism. Tubau JF, Wikman-Coffelt J, Massu BM et al. Diltiazem prevents hypertrophy progression, preserves systolic function, and normalises oxygen utilisation in the spontaneously hypertensive rat. Cardiovasc Res. Cardizem CD and Cartia XT may be administered without regard to meals.
The USP Drug Nomenclature Committee. Nomenclature policies and recommendations: I. Review and current proposals and decisions. Pharmacopeial Forum. If intolerable adverse effects occur, consider dosage reduction; if adverse effects worsen or fail to resolve, may need to discontinue and switch to another antihypertensive drug class. Hansten PD. Diltiazem and digoxin. Drug Interact Newsl. Gadde K, Calabrese JR. Diltiazem effect on carbamazepine levels in manic depression. J Clin Psychopharmacol. Do not chew or crush the tablet. Menon PA, Thach BT, Smith CH et al. Benzyl alcohol toxicity in a neonatal intensive care unit: incidence, symptomatology, and mortality. Am J Perinatol. Patel A, ADVANCE Collaborative Group, MacMahon S et al. Effects of a fixed combination of perindopril and indapamide on macrovascular and microvascular outcomes in patients with type 2 diabetes mellitus the ADVANCE trial: a randomised controlled trial. Lancet. Use this medication regularly to get the most benefit from it. To help you remember, use it at the same time each day. It is important to continue taking this medication even if you feel well. Most people with high blood pressure do not feel sick. For the treatment of high blood pressure, it may take 2 weeks before you get the full benefit of this drug. Safety and efficacy not established. Exertional Angina: Cardizem has been shown to produce increases in exercise tolerance, probably due to its ability to reduce myocardial oxygen demand. This is accomplished via reductions in heart rate and systemic blood pressure at submaximal and maximal exercise workloads. Concomitant use of diltiazem with beta-blockers or digitalis may result in additive effects on cardiac conduction. A patient with Prinzmetal's angina developed periods of asystole 2 to 5 seconds after a single dose of 60 mg of diltiazem see ADVERSE REACTIONS. There are no available data concerning dosage requirements in patients with impaired renal or hepatic function. If the drug must be used in such patients, titration should be carried out with particular caution. Chicago, IL. 60064 USA, Made in Canada. An adjustment in the diltiazem dose may be warranted. Weir MR, Josselson J, Giard MJ et al. Sustained-release diltiazem compared with atenolol monotherapy for mild to moderate systemic hypertension. Am J Cardiol.
Biovail Pharmaceuticals, Inc. Cardizem CD diltiazem hydrochloride capsules prescribing information. Morrisville, NC; 2001 Aug. Mylan. Diltiazem hydrochloride extended-release capsules, USP twice-a-day dosage prescribing information. Morgantown, WV; 1997 Jan. McClellan K. Unexpected results from MIDAS in atherosclerosis. Inpharma Wkly. Rate of absorption may be increased if Tiazac extended-release capsules are taken with a high-fat meal. Cardizem is to be used only by the patient for whom it is prescribed. Do not share it with other people. Facial flushing; irritation where the injection was given. Severe allergic reactions rash; hives; itching; difficulty breathing; tightness in the chest; swelling of the mouth, face, lips, or tongue; unusual hoarseness; fainting; severe or persistent dizziness or light-headedness; shortness of breath; slow or irregular heartbeat; sudden weight gain; swelling of the feet, ankles, or hands; symptoms of liver problems eg, dark urine, pale stools, persistent loss of appetite, right-sided stomach pain, yellowing of the skin or eyes. To make swallowing easier, ask your doctor or pharmacist if you can open a diltiazem capsule and sprinkle the medicine into a spoonful of applesauce. Swallow right away without chewing. Do not save the mixture for later use. Milner MR, Goldman ME. Diltiazem for the treatment of thyrotoxicosis. Arch Intern Med. Strubelt O, Diederich KW. Experimental investigations on the antidotal treatment of nifedipine overdosage. J Toxicol Clin Toxicol. Cardiac Failure: Administer inotropic agents isoproterenol, dopamine, or dobutamine and diuretics. Zemenick RB. Verapamil or diltiazem for acute rate control: which is best? Diltiazem Cardizem drug interaction: Propranolol Inderal. In: Hansten PD, Horn JR. Drug interactions analysis and management. Vancouver, WA: Applied Therapeutics, Inc; 1997: 244. Cartia XT extended-release capsules: Maximum 480 mg daily. Reproduction studies have been conducted in mice, rats, and rabbits.
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Second- or third-degree AV block unless a functioning ventricular pacemaker is in place. Cardizem. They can cause serious health problems that may not go away, and sometimes death. Get medical help right away if you have signs like red, swollen, blistered, or peeling skin with or without fever; red or irritated eyes; or sores in your mouth, throat, nose, or eyes. Flutter Study Group. Efficacy and safety of intravenous diltiazem for treatment of atrial fibrillation and atrial flutter. Am J Cardiol.
With IV therapy, hypotension, injection site reactions, vasodilation, arrhythmia. Szlachcic J, Hirsch AT, Tubau JF et al. Diltiazem versus propranolol in essential hypertension: responses of rest and exercise blood pressure and effects on exercise capacity. Am J Cardiol. This medication should be used only when clearly needed during pregnancy. Discuss the risks and benefits with your doctor. Some MEDICINES MAY INTERACT with Cardizem.
The information contained herein is not intended to cover all possible uses, directions, precautions, warnings, drug interactions, allergic reactions, or adverse effects. If you have questions about the substances you are taking, check with your doctor, nurse, or pharmacist. You may need to have an electrocardiogram ECG checked before starting Cardizem and while taking it. Discuss any questions or concerns with your doctor. The most commonly reported side effects include edema, headache, and dizziness. Some products that may interact with this drug include: amiodarone, digoxin, fingolimod. Dizziness occurred more frequently with higher doses.
In geriatric patients, plasma half-life of the drug may be increased. This medication can slow down the removal of other medications from your body, which may affect how they work. Horton R. Spinning the risks and benefits of calcium antagonists. Lancet. Protect from excessive humidity. Taler SJ, Agarwal R, Bakris GL et al. KDOQI US commentary on the 2012 KDIGO clinical practice guideline for management of blood pressure in CKD. Am J Kidney Dis.